HEALTH TRAIN EXPRESS
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Health Train continues to believe that social media will expand and flourish not only in the business world but also will change the game in healthcare, as much as EMR and HIE, and in a much more effective manner as it builds from the ground up.

Next Healthtrain will be Google +, a fast moving high speed maglev vehicle with enormous potential for health institutions and clinic communication.

It is now almost ten years since beginning their National HIE in a country much smaller than the U.S. Certainly their software designs are obsolete and not industry current.

Lansley said, "We will be moving to an innovative new system driven by local decision-making. This is the only way to make sure we get value for money from IT systems that better meet the needs of a modernized NHS" (Beckford, London Telegraph, 9/22).

Because most healthcare transactions take place in regions and not nationally it seems reasonable that the nationwide network should be built last. The interoperability standards have been set…things may evolve and what is the rush? How many patients receive treatment in LA, Chicago, and NY? Few travel that distance for routine treatments. The number of patiens who can afford national expeditions for treatment are limited.

So far HHS has dispensed over $ 600 million dollars in incentives, according to

Friday, September 23, 2011

TGIF. Many things happened this week which may impact many of us in the world of technology and internet applications.

Hewlett Packard replaced Lou Apotheker with Meg Whitman in the wake of the discontinuance of the HP Touchpad, the announcement of HP disbanding or selling their HP consumer product line (apparently their printer division will still continue, since it is the dominant printer manufacturer, and also produces significant revenue for HP.

The demise of Apotheker comes not so much from his decisions to make strategic changes, but his poor communication and people skills in dealing with his Board of Directors and the Stockholders. It must have seemed heavy-handed and the investors voted with a 50% reduction in stock price as many unloaded their shares in the weeks since the announcement was made. This came after only 11 months of Apotheker’s reign (apparently of terror). Reports were that Apotheker lacked some leadership abilities critical to management of a diverse HP enterprise.

On the internet side and Web 2.0 Social media announced the expansion of SM with Google +, Google Hangouts and several new versions all within the past three months. Google + gained 45 million new users in less than three months and the growth is still exponential. While Facebook states it has over 600 million users it is 6-7 or more years old. Analysis shows that FBs growth has stagnated. Users of both platforms have a diverse opinion of how G+ stacks up against.

There is a dichotomy of opinion. Many FB fans are intensely loyal and are vocal about G+s failings while some have willingly jumped the FB ship, announcing how ‘lame’ FB has become.

Google + has loosened it’s ban on pseudonyms for user names, but remains a non-commercial platform.FB remains the dominant marketing SM tool. Many enterprises have just adopted SM for marketing and G+ does not as yet have a significant user base (45 million for G+ vs. 600+million for Facebook.

In the past several weeks this writer spent about six hours a day on Google +. Part of it was a learning experience. I learned much about Hangouts.. Health care has much to learn from and use in Hangouts.

I held an ophthalmology video conference based upon a user list serve for ophthalmology which is international in scope well respected and attended daily. Users who usually only communicate in writing and once or less a year at meetings were able to see and talk in real time to discuss interesting cases, display images with the restrictions in place by HIPAA. I was able to share theHIPAA 18 never say data as a document during the conference.

What are it’s other potentials? Everyone will figure out a way to use it…patient education in small groups seems the first item, and communication of physicians in regard to operations of the practice (business) or associates and other practices. How about a section meeting of the medical staff. Multiple concurrent Google hangouts can be run with different Gmail addresses. (You will need a high performance graphic card or multiple display card) or separate PCs.

President Obama hold a five way Hangout (notice Harry Reid’s one finger salute to the Chief)

Google+s hangout offers a 10 way audio-video conference with the capability of sharing documents, screens, and videos. It seems to offer new functionality every day. It runs well in all the browsers. I have used it in Firefox, Chrome and even Safari (on a PC) Interesting that Safari which normally loads very slowly and has slower screen web page changes on my PC yields the best video performance on my laptop. Some of this may have to do with how video is rendered with the laptops meager video resources and memory sharing for video graphics.

FB countered in the past weeks with several new applications and major changes to the interface becoming much more visual with alterations in the “white space’ of their web pages. Zuckerberg announces TIMELINE.

HIPAA violations !!

And finally this news. Neutrino found exceeding the speed limit of light.

Wednesday, September 21, 2011

I have read that medical blogging has changed. The bloggers posting clinical cases and clinical information have declined, many (like life imitates art) are retiring, conflicted about HIPAA and privacy requirements.

Caseblog points out the 18 “never say'” items similar to the old bad 8 words of the 70s on television.

They are:

List of 18 Identifiers: (some of these were new to me)

1. Names;2. All geographical subdivisions smaller than a State, including street address, city, county, precinct, zip code, and their equivalent geocodes, except for the initial three digits of a zip code, if according to the current publicly available data from the Bureau of the Census: (1) The geographic unit formed by combining all zip codes with the same three initial digits contains more than 20,000 people; and (2) The initial three digits of a zip code for all such geographic units containing 20,000 or fewer people is changed to 000.3. All elements of dates (except year) for dates directly related to an individual, including birth date, admission date, discharge date, date of death; and all ages over 89 and all elements of dates (including year) indicative of such age, except that such ages and elements may be aggregated into a single category of age 90 or older;4. Phone numbers;5. Fax numbers;6. Electronic mail addresses;7. Social Security numbers;8. Medical record numbers;9. Health plan beneficiary numbers;10. Account numbers;11. Certificate/license numbers;12. Vehicle identifiers and serial numbers, including license plate numbers;13. Device identifiers and serial numbers;14. Web Universal Resource Locators (URLs);15. Internet Protocol (IP) address numbers;16. Biometric identifiers, including finger and voice prints;17. Full face photographic images and any comparable images; and18. Any other unique identifying number, characteristic, or code (note this does not mean the unique code assigned by the investigator to code the data)

Are the standards different for small practices and large institutions? Reality suggests this to be true:

There seems to be a discrepancy of the methods employed by doctors and institutions when using social media. We tell doctors: "never answer patient questions on Twitter". Yet, Cleveland Clinic runs regular Twitter chats soliciting patient questions which are then answered by doctors and healthcare personnel. Mayo Clinic and other institutions do the same.

A blog is your notebook for lifelong learning

Don't forget the most important thing: A blog is your notebook for lifelong learning. Doctors learn from their patients every day. Patients learn from their doctors every day too. Both groups must try their best to excel in the joint quest to achieve the best possible outcome.

Social Media in Medicine is particularly prevalent in the Emergency Department. Perhaps this is what ED physicians do during a quiet moment, between entries in the EMR. This should not be surprising since ER medicine reflects reality. The interface of what we plan and what happens in life while we plan it. Dramatic, crises, no one goes to an ER willingly, to wait, to see an unknown doctor unless uninsured or by other circumstance unable to make it to the doctors office during regular hours, due to transportation problems, and a simple fact that most ERs will see you no matter what to determine if it is safe to send you home. Most ERs are on a public transportation route.

Whether you are a blogger or a reader, perhaps these features will keep you focused on the never say words, or who is blogging, why and where of it all.

Facebook, Twitter, and Google + each have their own way of developing lists, groups and circles for groups, however none of them are secured by passwords for healthcare providers. It should also be noted that although the doctor only social networks are not HIPAA compliant….private and confidential patient matters should be de-identified.

Anyone reading a government website knows they do not use smart graphics design. Even HHS admits this since they have started a new website, more oriented to reader understanding.

The old website is still available.

Two Websites, One Message

ONC’s existing website will remain housed at healthIT.hhs.gov. The HHS site will become more policy and program-focused, and HealthIT.gov will serve as a primary resource for providers and patients who are interested in learning more about how health IT can help improve their health and health care. The new website provides access for patients as well as providers .

Wednesday, September 14, 2011

Next time you go to see your MD don’t worry about the seemingly inane questions he / she will ask you. If he doesn’t he will be in violation of a new ICD coding initiative installed by HHS in the next two years.

And for you astronauts you are covered for spacecraft incidents, except for re-entering the atmosphere without a space-ship.

Tuesday, September 13, 2011

Like it or not, the feds have released their ‘edict’ for adopting the digital age for EMR, and HIEs.(Office of the National Coordinator for Health Information Technology).

Anyone reading my blog knows that I am not a luddite,, and I tend to err on the side of caution. Like most surgeons my first thoughts are ‘primum non nocere’. (first do no harm).

For all physicians and leaders this is a must read, It was developed after a 90 day period of public comment, and the document states it is still subject to revision(s).

The document includes the following information:

“Request for More Information on Outreach and Education to Providers and ConsumersIn order to achieve the highest participation possible in the Medicare and Medicaid EHR Incentive Programs, ONC and CMS are working together on a coordinated outreach and education campaign directed at providers and hospitals. Our approach is two-pronged and involves distributing critical information and materials nationally, while focusing on local communities to engage audiences where they live and work. We’ve already started collaborating with stakeholders and the media to distribute materials and established a strong online presence through social media.

In addition, ONC and the Office for Civil Rights are gearing up to launch a national campaign this month, designed to increase consumers’ awareness about:

The transition to health IT;

How to access their health information;

The benefits of leveraging health IT tools to better manage their health; and

Privacy rights to access and protect their health information.

Does this mean HIT is now a ‘civil right’? Will it be subject to enforcement if a provider does NOT provide an EMR, or is this the way our bloated government deals with publicizing items for public consumption? Perhaps I am over-reacting here…I will have to call Glenn Beck and get his opinion.

BTW Glenn now has his own Internet TV network at GBTV.com (Unashamed promotional material given without financial compensation (my charitable donation to freedom )

Disclaimer

The opinions in this blog or other forms of social media are solely that of Gary M. Levin M.D. Dr. Levin has no financial interests in any medical devices which are discussed or which appear in the blog. Commentary taken from other sources are either quoted or referenced with attribution. Dr Levin does not endorse, nor give financial support to any political organizations.